Quality and price--impact on patient satisfaction

Patient satisfaction in China: a national survey of inpatients and outpatients

OBJECTIVES

Patient satisfaction is an important indicator of hospital healthcare quality. Little up-to-date information of patient satisfaction in China is available. This study attempts to gain a holistic understanding of patient satisfaction in China and identify the key antecedents of patient satisfaction.

DESIGN

A cross-sectional national survey was conducted in 2018.

SETTING

Hospitals in 27 provinces and 4 municipalities in 4 regions of China.

PARTICIPANTS

A random sample of 15 699 patients who visited 1304 hospitals were surveyed, with around 500 from each of the 27 provinces and 4 municipalities.

PRIMARY AND SECONDARY OUTCOME MEASURES

The Hospital Consumer Assessment of Healthcare Providers and Systems questionnaire was used to measure patients' overall satisfaction and willingness to recommend the hospital.

RESULTS

We found significant variation in overall patient satisfaction but little variation in hospital recommendation across the four broad regions. Moreover, we examined determinants of patient satisfaction and their likelihood to recommend the hospital. The overall satisfaction for inpatients and outpatients is commonly influenced by communication with doctors (inpatient: β=0.524, p<0.001; outpatient: β=0.541, p<0.001), hospital cleanness (inpatient: β=0.165, p<0.05; outpatient: β=0.144, p<0.001) and acceptable charges (inpatient: β=1.481, p<0.001; outpatient: β=1.045, p<0.001). Both inpatients and outpatients are more likely to recommend the hospital if there are communication with doctors (inpatient: OR=1.743, p<0.001; outpatient: OR=1.647, p<0.001), acceptable charges (inpatient: OR=2.660, p<0.001; outpatient: OR=2.433, p<0.001). Outpatient satisfaction and hospital recommendation are also influenced by time spent with doctors (satisfaction: β=0.301, p<0.001; recommend: OR=1.430, p<0.001) and waiting time (satisfaction: β=-0.318, p<0.001; recommend: OR=0.844, p<0.001).

CONCLUSIONS

There are regional differences of patient satisfaction in China. Patient satisfaction is influenced by a variety of hospital factors and province/municipality factors. The influencing factors of patient satisfaction may not motivate patients to recommend the hospital.

A Comparative Study of Liver Disease Care in the USA and Urban and Rural China

BACKGROUND

Chronic liver disease is a major cause of morbidity and mortality in the USA and China, but the etiology of liver disease, medical practice, and patient expectations in these two countries are different.

AIMS

To compare patient knowledge about their liver disease, patient satisfaction with liver disease care, and patient medical decision-making preference in the USA and China.

METHODS

Three cohorts of established adult patients with liver disease seen in liver clinics in Ann Arbor, USA, and Beijing (urban) and Hebei (rural), China, completed a survey between May and September 2014.

RESULTS

A total of 990 patients (395 USA, 398 Beijing, and 197 Hebei) were analyzed. Mean liver disease knowledge score (maximum 5) in the USA, Beijing, and Hebei patients was 4.1, 3.6, and 3.0, respectively (p < 0.001). US patients had a greater preference for collaborative decision-making: 71.8 % preferred to make treatment decisions together with the doctor, while most Chinese patients (74.6 % Beijing and 84.8 % Hebei) preferred passive decision-making. Mean satisfaction score (maximum 85) in the USA was higher than in Beijing, which in turn was higher than in Hebei (78.2 vs. 66.5 vs. 60.3, p < 0.001). There was a positive correlation between liver disease knowledge score and satisfaction score (r = 0.27, p < 0.001) and with collaborative medical decision-making (r = 0.22, p < 0.001) when responses from all sites were combined.

CONCLUSIONS

Liver disease knowledge and patient satisfaction were greatest in the USA, followed by Beijing and then Hebei patients. Understanding these differences and associated factors may help to improve patient outcomes.

Perceptions of care quality and the effect on patient satisfaction

Purpose

This research models the impact of patient perceptions of care quality on overall patient satisfaction in a rural healthcare organization over a three-year time period. The purpose of this paper is to determine if the factors that influence perceptions of service quality change over time and if the change affects overall patient satisfaction.

Design/methodology/approach

Data were collected for three fiscal years (2012-2014) using a 36-question, Likert-scaled attitudinal survey. Multiple regression analysis was performed to identify which constructs of five different service quality dimensions were statistically significant in predicting overall patient satisfaction. Paired comparison of means and ANOVA F-tests highlighted significant differences across years and demographics.

Findings

Multiple regression models of overall patient satisfaction over a three-year time period had significant repeat variables, indicating salience of the dimensions and constructs of service quality that predict patient satisfaction. However, some dimensions of service quality did not remain significant from one year to another, indicating there may be a gap in the patient service cycle over an extended time frame.

Originality/value

This paper explored the sequential relationship between patient satisfaction survey data and perceptions of service quality over a multi-year time frame. The research focussed on outpatient medical clinics, while the majority of previous studies have focussed on acute care or inpatient stays. A longitudinal study is especially relevant for outpatient clinics where continuity of care is important.